Electrical impedance tomography-guided positive end-expiratory pressure titration in ARDS: a systematic review and meta-analysis

Nickjaree Songsangvorn; Yonghao Xu; Cong Lu; Ori Rotstein; Laurent Brochard; Arthur S Slutsky; Karen E A Burns; Haibo Zhang

doi:10.1007/s00134-024-07362-2

Electrical impedance tomography-guided positive end-expiratory pressure titration in ARDS: a systematic review and meta-analysis

Intensive Care Med. 2024 May;50(5):617-631. doi: 10.1007/s00134-024-07362-2. Epub 2024 Mar 21.

Authors

Nickjaree Songsangvorn^{1

2}, Yonghao Xu^{3

4}, Cong Lu¹, Ori Rotstein^{1

5}, Laurent Brochard^{1

6}, Arthur S Slutsky^{1

6}, Karen E A Burns^{1

6}, Haibo Zhang^{7

8

9

10}

Affiliations

¹ Keenan Research Centre for Biomedical Science and the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
² Department of Critical Care Medicine, Bhumibol Adulyadej Hospital, Bangkok, Thailand.
³ Keenan Research Centre for Biomedical Science and the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. dryonghao@163.com.
⁴ The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. dryonghao@163.com.
⁵ Department of Surgery, University of Toronto, Toronto, ON, Canada.
⁶ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
⁷ Keenan Research Centre for Biomedical Science and the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. haibo.zhang@unityhealth.to.
⁸ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. haibo.zhang@unityhealth.to.
⁹ Department of Physiology, University of Toronto, Toronto, ON, Canada. haibo.zhang@unityhealth.to.
¹⁰ Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada. haibo.zhang@unityhealth.to.

Abstract

Purpose: Assessing efficacy of electrical impedance tomography (EIT) in optimizing positive end-expiratory pressure (PEEP) for acute respiratory distress syndrome (ARDS) patients to enhance respiratory system mechanics and prevent ventilator-induced lung injury (VILI), compared to traditional methods.

Methods: We carried out a systematic review and meta-analysis, spanning literature from January 2012 to May 2023, sourced from Scopus, PubMed, MEDLINE (Ovid), Cochrane, and LILACS, evaluated EIT-guided PEEP strategies in ARDS versus conventional methods. Thirteen studies (3 randomized, 10 non-randomized) involving 623 ARDS patients were analyzed using random-effects models for primary outcomes (respiratory mechanics and mechanical power) and secondary outcomes (PaO₂/FiO₂ ratio, mortality, stays in intensive care unit (ICU), ventilator-free days).

Results: EIT-guided PEEP significantly improved lung compliance (n = 941 cases, mean difference (MD) = 4.33, 95% confidence interval (CI) [2.94, 5.71]), reduced mechanical power (n = 148, MD = - 1.99, 95% CI [- 3.51, - 0.47]), and lowered driving pressure (n = 903, MD = - 1.20, 95% CI [- 2.33, - 0.07]) compared to traditional methods. Sensitivity analysis showed consistent positive effect of EIT-guided PEEP on lung compliance in randomized clinical trials vs. non-randomized studies pooled (MD) = 2.43 (95% CI - 0.39 to 5.26), indicating a trend towards improvement. A reduction in mortality rate (259 patients, relative risk (RR) = 0.64, 95% CI [0.45, 0.91]) was associated with modest improvements in compliance and driving pressure in three studies.

Conclusions: EIT facilitates real-time, individualized PEEP adjustments, improving respiratory system mechanics. Integration of EIT as a guiding tool in mechanical ventilation holds potential benefits in preventing ventilator-induced lung injury. Larger-scale studies are essential to validate and optimize EIT's clinical utility in ARDS management.

Keywords: ARDSNet; Mechanical ventilation; Ventilator-induced lung injury.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Electric Impedance*
Humans
Positive-Pressure Respiration* / methods
Respiratory Distress Syndrome* / physiopathology
Respiratory Distress Syndrome* / therapy
Respiratory Mechanics / physiology
Tomography* / methods
Ventilator-Induced Lung Injury* / prevention & control

Abstract

Publication types

MeSH terms

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